By Jane F. Gilgun and Samantha Hirschey, University of Minnesota, Twin Cities, USA

In the previous blog, we discussed girls’ aggression as executive function and self-regulation issues. In this blog, we illustrate points about executive function and self-regulation with a case study of Antonia, a young African American girl who developed prosocial behaviors through relationships of trust with a long-term case manager, with some of her teachers, and with supervisors at an after-school job.

Antonia

Antonia, a bright and attractive African-American girl, had experiences similar to many other girls in child welfare caseloads. Antonia was born to a teenage mother who rejected her at birth because Antonia was conceived through rape. Her mother placed her with aunts where Antonia thrived. She rarely saw her mother. At five, her mother took her on what she told her aunts was an outing. Instead, the mother moved 500 miles away and took Antonia.

By this time, her mother had married and had another child whom she showered with love. Her mother not only ignored Antonia but emotionally abused her, calling her names and telling her she was the cause of her mother’s problems. She also physically abused her. She and her husband often engaged in mutual verbal and physical aggression and abused drugs and alcohol. In one year, police responded 27 times to calls to the family home because of domestic abuse. Antonia saw her stepfather escorted from the home in handcuffs many times. Her mother turned in on herself at this time and did not offer comfort to Antonia. Her stepfather rarely paid attention to Antonia and sometimes physically abused her. He favored his biological children.

Antonia, therefore, experienced complex trauma. By age nine, her family was reported to child protection for abuse and neglect. A service provider investigated and substantiated maltreatment. Antonia’s child welfare social worker provided services to the family. Antonia remained in the home. The social worker was often called to the school when Antonia was in trouble for fighting.

The child welfare service provider noticed that Antonia was able to carry on in situations where she felt safe. She had excellent verbal communication skills and did well in school and organized activities, but she had difficulty reading social cues and often verbally abused and attacked girls she thought were talking about her. She had a few girlfriends with whom she usually had amicable relationships. At times, when she felt threatened, she controlled them through threats to exclude them. The three girls sometimes engaged in relational aggression with other girls who were new to the school. Antonia enjoyed being the center of the attention and used her superior verbal skills to maintain her status. She therefore has issues with physical and relational aggression.

The child welfare social worker was concerned that Antonia would be expelled from school and follow a trajectory that would replicate her mother’s life. With hope for something better for Antonia, she referred Antonia to an agency that specializes in work with children who are members of high-risk families and may be on a trajectory toward long-term anti-social behaviors and involvement in juvenile justice systems.

The program, called All Children Excel (ACE) provides case management services for children from high-risk situations for as long as they are needed or up until the age of 18, whichever comes first. Antonia entered the program at age nine and continued until she was 18. She had the same case manager, whom we call Mary, for those years.

After many ups and downs, Antonia formed a trusting relationship with Mary, her case manager. Slowly, Antonia stopped fighting other girls and thinking that they were talking about her. She appeared to stop her relational aggression. She realized that her behaviors were hurting others and herself and only made her feel worse in the long run. The case manager advocated for Antonia with teachers, school social workers, and administrators. In general, school personnel were responsive. Rather than isolating Antonia for aggressive behaviors, they allowed her to phone her case manager, which helped Antonia to calm down and return to the classroom.

School officials also allowed her to meet with the school social worker with whom she openly shared what was happening when she acted out and how her home life affected her.

School officials had a good working relationship with Mary the case manager for many years. Two teachers who specialized in children with emotional and behavioral problems were of great help to Antonia in helping her to view herself as worthy of respect and love. They applied the principles of the School-Wide Positive Behavioral Interventions and Supports (SWPBIS) that emphasizes the setting of clear expectations and the reward of prosocial behaviors.

With the recommendation and support of Mary, Antonia obtained a job in a plant nursery after school and on weekends. She excelled. At times, she became dysregulated and wanted to walk out on the job, but she phoned her case manager who helped her to re-regulate and think about consequences.

Antonia saved most of the money she earned for college and to buy clothes. She invited a classmate to her senior prom, and her case manager said she looked beautiful in the dress she bought with her own money. Her mother and stepfather allowed her to keep the money she earned, although they continued to have conflicts and also continued at times to verbally abuse and neglect Antonia.

Today, Antonia is in her second year of college, studying horticulture, in the city where her aunts live. She lives with her aunts, has close friends, and looks forward to a fulfilling future. She will require emotional support when she runs into inevitable difficulties. Hopefully, she has learned to trust others and will seek professional services for emotional support when she needs it.

The key issues that turned Antonia’s life around was her long-term relationship of trust with her case manager, Mary. Mary stuck with her and listened when Antonia was troubled and dysregulated. They eventually formed a relationship of trust.

Research supports the centrality of relationships when social services have good outcomes. From all accounts, Antonia had secure attachments with her aunts and other family members from birth to the age of five. These early secure attachments are likely to have played a part in her eventual secure attachments with others. In general, when working with young people who act in aggressive ways, assessment for secure attachment experiences is important to do.

Research also has shown that factors external to service provider-service user relationships have great weight in outcome. The case manager built relationships with key school personnel who understood Antonia and helped her to deal with her self-defeating behaviors. The case manager, therefore, worked effective with external factors that otherwise might have undermined her work with Antonia.

Antonia already had good executive function and self-regulation skills when she felt safe. Building on her relationship of trust with her case manager, Antonia was able to widen her circle of trust and security to include situations where formerly she would revert to physical and relational aggression. The settings in which Antonia had good executive functions widened as her circles of trust widened.

Questions To Consider

Please feel free to leave a comment on today’s blog. As you think about the blog, we wonder how you are responding to the ideas we presented. What, for example, do you think we left out? Was there anything in this blog that helped you think more deeply about your cases? In addition, please consider the following questions.

  • Have you been a service provider in cases similar to Antonia’s? What led to the outcome?
  • This case shows the centrality of relationships of trust to good outcomes. Have you noticed that your own effectiveness depends on the relationships you develop with young people and their families?
  • Service providers often have to work with many other people, such as educators and parents, in order to facilitate good outcomes. Please provide examples of relationships you have had with other professionals and parents that were factors in good outcomes.

Next Blog

The next blog covers differential assessment whose purpose is to understand the risks and resources present in the lives of service users and then to make recommendations for case planning based on the distribution of risks and resources. The kinds and intensity of interventions depend upon the risk and resource profiles of young people. Young people who have multiple risks including complex trauma, like Antonia, require intensive, long-term intervention while young people with low risks and high resources will respond to short-term and even one-time interventions.

About the Authors

Jane F. Gilgun, Ph.D., LICSW, is a professor, School of Social Work, University of Minnesota, Twin Cities, USA. She was a child welfare social worker for more than eight years and has taught courses and done qualitative research on high-risk children and families for many years. A special focus of her research is factors associated with good outcomes when children have experienced complex trauma. Professor Gilgun’s articles, books, and practice manuals are widely available on the internet. Many of them are free.

Samantha Hirschey is a second year master’s student at the School of Social Work, University of Minnesota, USA, and Professor Gilgun’s research assistant. She did her first year internship at the St. Paul Public Schools and her second internship will be at the Community-University Health Care Center that provides mental health services to residents of the inner city of Minneapolis. She has worked in a variety of social service agencies including with children, teens, and adults with mental illnesses and developmental disabilities. She has a special interest in the promotion of integrated behavioral health in children and families.

References

Appleyard, Karen, Byron Egeland, Manfred H.M. van Dulmen, and L. Alan Sroufe (2005). When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry 46(3), 235–245.

Blair, Clancy, Philip David Zelazo, and Mark T. Greenberg, (2005). The measurement of executive function in early childhood. Developmental Neuropsychology. 28(2), 561–571.

Cunningham, Jera Nelson, Wendy Kliewer, & Pamelaw Garner (2009). Emotion socialization, child emotion understanding and regulation, and adjustment in urban African American families: Differential associations across child gender. Development and Psychopathology, 21, 261–283

Deater-Deckard, Kirby, Zhe Wang, Nan Chen, & Martha Ann Bell (2012). Maternal executive function, harsh parenting, and child conduct problems. Journal of Child Psychology and Psychiatry 53(10), 1084–1091.